Audits and Coding Quality Reviews

The OIG and CMS recommend “regular” reviews, but give no guidance as to frequency. We suggest that our clients establish an annual budgetary amount, and then stagger it in quarterly reviews instead of one large annual evaluation. The cost is the same and has three major benefits. First, the expense of the audit is spread throughout the year. Second, the providers and coders receive feedback on the status of the coding throughout the year. Third, a program of regular quarterly feedback provides an opportunity to correct the errors identified and then confirm that the corrective action has been effective without having to wait an entire year. If coding errors continue to occur, then a targeted plan of action can be instituted.

The implementation and operation of this program is quite simple. Periodically (monthly, quarterly, semi-annually, or annually) participating practices send us a representative sample of their visit notes, procedure reports and claim forms. We perform a government-style audit of the coding, using all available screens and regulations. We then send you a case-by-case analysis of our findings. Our medical coding and surgical coding accuracy evaluations are designed to be part of a continuous quality improvement program. It gives our clients’ medical coders and surgical coders the feedback they need to more accurately code the patient-care services.

Have you been the target of a compliance audit? If you think you’re being treated unfairly, let us “audit the auditors.” Our findings can be your best defense!

Latest Blog Posts:

  • Screen Shot 2017-03-29 at 12.11.37 PM

OIG Posts a Resource Compliance Guide & Enforcement Action

March 29th, 2017|Comments Off on OIG Posts a Resource Compliance Guide & Enforcement Action

You can use the links provided and go directly to the OIG material.

The OIG has developed free educational resources listed are to help health care providers, practitioners, and suppliers understand the health care […]

  • 022017 Reza Accenture 712

1 in 4 health consumers have had their PHI stolen

February 21st, 2017|Comments Off on 1 in 4 health consumers have had their PHI stolen

26% of United States health consumers have had their PHI stolen from healthcare systems, according to the results of a study from Accenture, released in Orlando at HIMSS17. The study reveals that 50% of people […]

  • shutterstock_177013181

Healthcare Provider will pay $60 Million Settlement for Medicare and Medicaid False Claims

February 13th, 2017|Comments Off on Healthcare Provider will pay $60 Million Settlement for Medicare and Medicaid False Claims

TeamHealth Holdings, a major U.S. hospital service provider, has agreed to resolve allegations that it violated the False Claims Act by billing Medicare, Medicaid, the DHA, and the Federal EHB Program for higher and more […]

  • Fraudulent-Health-Insurance-Claims

Federal government reclaims $3.3B+ in fraudulent healthcare claims

February 1st, 2017|Comments Off on Federal government reclaims $3.3B+ in fraudulent healthcare claims

The Office of the Inspector General has reported that the federal government has recovered over $3 billion in fraudulent healthcare claims in the 2016 fiscal year.

Read More Here